Mental Illnesses a Leading Cause of Hospital Admissions, But Treatment Lags Behind

Would you send your mother to a pediatrician for her arthritis, or your child to a geriatrician for his well-baby exam?

Probably not – unless there were no other provider in town.

But some new reports from the Agency for Healthcare Research and Quality (AHRQ) suggest that something akin to that is happening every day to people with mental illnesses.

Two reports – Costs for Hospital Stays in the United States, 2010 and Most Frequent Conditions in U.S. Hospitals, 2010 – were released in January 2013.  The third, Most Frequent Procedures Performed in U.S. Hospitals, 2010, was released in February.

They make for fascinating reading, with an unexpected twist at the end. 

Spoiler alert – mood disorders are among the most common reasons for hospitalizations for people under 65.  But mood disorders aren’t driving the increase in hospital costs, because the procedures hospitals most often perform have nothing to do with treating people with mood disorders.

Mood disorders accounted for 877,000 hospital inpatient stays during 2010.  Apart from being born, they were the #1 reason that children under the age of 18 were admitted to hospitals, ahead of pneumonia, asthma, and appendicitis.

Mood disorders were also the 3^rd most common primary diagnosis among all people between the ages of 18 and 44.  The other four in the top five all related to childbirth and delivery.

And among adults between the ages of 45 and 64, mood disorders ranked 5^th as a reason for inpatient hospitalization, behind four conditions closely related to aging – osteoarthritis, back pain, chest pain, and coronary artery disease.

Mood disorders may be common reasons for hospitalization, but they have nothing to do with the recent increase in health care costs.

The mean cost of a hospital stay was $9,700 in 2010, up from $6,700 (in 2010 dollars) in 1997.  That represents a 45% increase over a thirteen year period. 

But the mean cost for mood disorders was less than half of that – just $4,800.  And what’s even more interesting is this.  That represented a 6% decrease from the $5,100 cost per stay in 1997.

On the other end of the scale, the most expensive hospital stay was for adult respiratory arrest, at $22,300.  In other words, we pay almost five times more for people to die in a hospital than to be treated for mental illness in a hospital. 

We also pay $18,000 to diagnose and treat an acute brain injury – four times than what we pay to diagnose and treat a chronic brain disease.

And in every age group, the most common procedures hospitals perform have nothing to do with mood disorders. 

Among children, hospitals most frequently offer vaccinations, circumcisions, respiratory intubations, and appendectomies.  Among younger adults, the most frequent procedures include those related to child birth and delivery – such as Caesarian sections and repairs of obstetric lacerations, and blood transfusions.  And among older adults, blood transfusions, cardiac catheterization, respiratory intubation, and upper GI endoscopy are most common, along with knee and hip procedures for the very old.

So what do we need to do to respond to the needs of people with mood disorders who are entering our hospitals?

The answer isn’t to deny or restrict care to patients with mental illnesses who show up at hospitals because they have no other place to go, or to force hospitals to discharge patients with mood disorders before they are ready to go, or to wait for jails to pick up the slack – as we do in so many places today.

We have choices.

One is to fund more community treatment programs – to replace those we lost to massive budget cuts – so that thousands of people can avoid hospitalizations in the first place.

And another is to insist that when patients are admitted to hospitals, our new mental health parity rules and regulations mandate payment for hospitals to use new procedures like functional MRIs (fMRIs) to diagnose more accurately – and therefore to treat more effectively – mental illness in their patients. FMRIs are brain scans that can show differences in brain activity that are correlated with specific mood and anxiety disorders. 

FMRIs aren’t exotic – they have already been used in consumer studies to measure consumer preferences for brand names. If we can use fMRIs to help sell cola or political candidates, why can’t we use them in hospitals to help treat mental illness?

We always have choices.

To reach Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/